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Porter, L.

Publications and source records attributed to Porter, L..

2 recordsLinked to original sources

Sensory Over-Responsivity: Parent Report, Direct Assessment Measures, and Neural Architecture

BackgroundSensory processing differences are common across neurodevelopmental disorders. Thus, reliable measures are needed to understand biologic underpinnings of these differences. This study aims to define a scoring methodology specific to tactile (TOR) and auditory (AOR) over-responsivity. Second, using MRI Diffusion Tensor Imaging, we seek to determine whether children with AOR show measurable differences in their white matter integrity.\n\nMethodsThis study includes children with AOR and TOR from a mixed neurodevelopmental disorders cohort including autism and sensory processing dysfunction (n= 176) as well as neurotypical children (n= 128). We established cut-off scores for over-responsivity using the parent report: Short Sensory Profile (SSP), and the direct assessment: Sensory Processing-Three Dimensions:Assessment (SP-3D:A). Group comparisons, based on AOR phenotype, were then conducted comparing the white matter fractional anisotropy in 23 regions of interest.\n\nResultsUsing the direct assessment, 31% of the children with neurodevelopmental disorders had AOR and 27% had TOR. The Inter-test-agreement between SSP and SP-3D:A for AOR was 65% and TOR was 50%. Children with AOR had three white matter tracts showing decreased fractional anisotropy relative to children without AOR.\n\nConclusionsThis study identified cut scores for AOR and TOR using the SSP parent report and SP-3D:A observation. A combination of questionnaire and direct observation measures should be used in clinical and research settings. The SSP parent report and SP-3D:A direct observation ratings overlapped moderately for sensory related behaviors. Based on these initial structural neuroimaging results, we suggest a putative neural network may contribute to AOR.

neuroscience

Targeting regulatory T cells with Interleukin-2 treatment in type 1 diabetes: a response-adaptive, non-randomised, open-label trial of repeat doses of Aldesleukin (DILfrequency)

BackgroundType 1 diabetes (T1D) results from loss of immune regulation leading to the development of autoimmunity to pancreatic beta-cells, involving autoreactive T effector cells (Teffs). Regulatory T cells (Tregs), that prevent autoimmunity, require Interleukin-2 (IL-2) for maintenance of immunosuppressive functions and, alterations in the IL-2 pathway predispose to T1D. Using an adaptive trial design we aimed to determine the optimal regimen of aldesleukin (recombinant human IL-2) to physiologically enhance Tregs while limiting expansion of autoreactive Teffs.\n\nMethodsDILfrequency is a single-center, non-randomised, open-label, response-adaptive study of participants aged 18 to 70 years with T1D. The initial learning phase allocated 12 participants to six different predefined dose-frequency regimens. Then, three cohorts of 8 participants were sequentially allocated dose-frequencies, based on repeated interim analyses of all accumulated trial data. The co-primary endpoints were percentage change in Tregs, Teffs and, CD25 ( subunit of the IL-2 receptor) expression by Tregs, from baseline to steady state. Trial registration ISRCTN40319192 and ClinicalTrials.gov (NCT02265809).\n\nFindings115 participants were assessed between November 17th 2014 and May 22nd 2016, 38 participants were enrolled with 36 completing treatment. The optimal regimen to maintain a steady state increase in Tregs of 30% and CD25 expression of 25% without Teff expansion is 0.26 x 106 IU/m2 (95% CI (-0.007 to 0.485)) every 3 days (1.3 to 4.4). Tregs and CD25 were dose-frequency responsive, while Teffs were not. The commonest adverse event was injection site reaction (464/694 events), with a single participant developing transient eosinophilia at the highest dose (0.47 x 106 IU/m2).\n\nInterpretationThis response-adaptive trial defined a well-tolerated aldesleukin regimen that specifically induces Treg expansion that can now be trialled to treat T1D.\n\nFundingSir Jules Thorn Trust, Wellcome, JDRF, SNSF, NIHR

clinical trials